Spectacle use and effective refractive error coverage in people experiencing homelessness: The Homelessness in Ribeirão Preto Eye Study (HOPES)

Abstract

Purpose : To investigate the use of spectacle and the effective refractive error coverage (eREC) among individuals experiencing homelessness in Ribeirão Preto, Brazil.

Methods : From May 2023, a cross-sectional study was conducted in 9 support centers in Ribeirão Preto, targeting individuals 18 or older experiencing homelessness. The protocol consisted of presenting (PVA) and best-corrected visual acuity (BCVA) measurement from each eye for distance and near, and a comprehensive eye examination. Spectacle usage was documented. The eREC for distance (eRECd) and near vison (eRECn) was calculated considering the ratio of subjects who presented with spectacles and whose PVA was ≥20/40 in the better eye (met need) by the sum of the subjects who presented with spectacles and whose PVA was <20/40 in the better eye improving to ≥20/40 with adequate refraction (undermet need) and those with PVA <20/40 in the better eye who did not have correction and who improved to ≥20/40 on refraction (unmet need), as follows: [met need/(met need+ undermet need+ unmet need)] x100. Associations of eREC with demographic data were investigated by multiple logistic regression.

Results : Of 371 invited subjects, 349 (94.0%) agreed to participate (85.1% men; n=297). Visual acuity and spectacle use data were collected from 336 subjects; 21 were wearing spectacles for distance vision and 12 for near vision. eRECd was 9.57 (5.33 – 16.58) in men and 5.88 (0.65 – 37.28) in women; 5.88 (1.39 – 21.97) in subjects aged 18-39 years old, 8.75 (4.16 – 17.48) in subjects aged 40-59 and 11.76 (2.51 – 40.85) in those aged 60+. Regarding the years living in homelessness, eRECd was 15.79 (8.26 – 28.09), 5.41 (1.26 – 20.30), and 2.78 (0.35 – 18.74) in those reporting less than one year, 1 to 5, and 5+ living in homelessness, respectively. eRECd in those who completed primary education was 5.56 (2.05 – 14.18), 8.89 (3.24 – 22.10) for those who completed high school, and 33.33 (4.18 – 85.14) for those with higher education. The overall eRECn was 2.66 (1.10 – 6.28). There is a trend for a better eRECd in older individuals, those with higher educational levels, and those experiencing homelessness for less than one year, but without statistical significance.

Conclusions : The findings underscore the importance of refractive error services for people experiencing homelessness.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.